| NPI | 1295744050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 1621) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 112315-9934) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2007-09-10 |